Multisystemisk terapi i Sverige - evidensbaserad metod i nytt sammanhang

This dissertation deals with the transferability of an evidence-based treatment method from one cultural context to another, with Multisystemic Therapy (MST) in Sweden as an example. The primary research question is whether the evidence-based treatment intervention MST can be transferred from the US to Sweden with retained treatment effects. This thesis is organized around four separate but interrelated studies. The first of these studies focused on the annual incidence and childhood prevalence of children and youth receiving child welfare interventions in Sweden. It showed that the annual incidence and childhood prevalence of child welfare services among adolescents were comparably high. The second study, a randomized trial, assessed the effectiveness of MST within the normally operating social service system for 156 youths who met the diagnostic criteria for conduct disorder. Youth were randomly assigned between MST and treatment-as-usual (TAU) groups. Assessments were conducted at intake as well as seven and 24 months after referral. The study presents the outcomes after 24 months. Results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behavior among participants across treatments. There were no significant differences between the two groups. Although the results also indicate that it was possible to implement MST in Sweden with the same treatment effects as in the US, several possible explanations to the results were investigated including treatment adherence and socio demographical and systemic differences between the US and Sweden. The third study examined weather MST treatment adherence changed during the first six years among Swedish MST teams, factors that account for identified changes, and how treatment adherence was related to post-treatment outcomes. Fidelity data were obtained from 973 families receiving MST from 68 therapists in ten Swedish teams. Results suggested that more than a year of activity was needed to significantly increase therapist treatment adherence. The collective experience of MST within the MST teams seemed to be the variable of primary importance to treatment adherence. The results presented a modest correlation between high treatment adherence and preferable post-treatment outcomes. The fourth and final study was a review that addresses the issue of interpreting results from effectiveness studies which utilize TAU as a comparator. A meta-analysis suggested a striking heterogeneity in achieved results between the studies included, and the hypothesis that context may affect the outcome was not contradicted. Results highlighted the importance of paying attention to the conditions under which the method has been proven effective